Should We Abandon Routine Visits? There Is Little Evidence for or Against

Hematuria as a Marker of Occult Urinary Tract Cancer: Advice for High-Value Care From the American College of Physicians

Background: The presence of blood in the urine, or hematuria, is a common finding in clinical practice and can sometimes be a sign of occult cancer. This article describes the clinical epidemiology of hematuria and the current state of practice and science in this context and provides suggestions for clinicians evaluating patients with hematuria. Methods: A narrative review of available clinical guidelines and other relevant studies on the evaluation of hematuria was conducted, with particular emphasis on considerations for urologic referral. High-Value Care Advice 1: Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria. High-Value Care Advice 2: Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults. High-Value Care Advice 3: Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults. High-Value Care Advice 4: Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited. High-Value Care Advice 5: Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause. High-Value Care Advice 6: Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy. High-Value Care Advice 7: Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.

Maintenance of Certification Status and Performance on a Set of Process Measures

Reported Outcomes of the Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain Article

Annals for Educators - 20 August 2019

Care of the Patient With Asthma

Nearly 8% of the U.S. population is diagnosed with asthma, leading to more than 5 million office visits and 1 million emergency department visits annually. Both outpatient and inpatient internal medicine clinicians treat asthma frequently, but nuances in diagnosis and management have emerged. This article highlights many of these developments.

Modernizing Risk Adjustment in Health Care: A Position Paper of the American College of Physicians

Risk adjustment is a critical component of health care reimbursement aimed at ensuring fair compensation on the basis of the characteristics of patients receiving care. Optimizing risk adjustment is not just a matter of improving efficiency or predictive accuracy; it is a crucial step toward achieving health equity by ensuring that resources are directed toward patients who need them most and reducing incentives to exclude or neglect high-risk patients. The authors reviewed available publications from PubMed and Google Scholar published between 2000 and 2025, as well as relevant news articles, policy documents, websites, and other sources related to risk adjustment and application areas. This process yielded 8 recommendations related to standardizing risk adjustment methods, promoting data interoperability, implementing strategies to enable more accurate and continuous reflections of patients’ health status, integrating valid and reliable metrics into regular evaluation and feedback mechanisms, limiting “gaming” opportunities and incentives, creating valid ways to measure costs of caring for patients who are experiencing health care disparities and inequities and/or are disproportionately affected by social drivers of health, evaluating and leveraging advanced analytics and machine learning when able to improve risk adjustment models, and promoting research and implementation methods that combine elements of both prospective and concurrent risk adjustment. Implementation of these risk adjustment recommendations has broad implications for various entities in the health care ecosystem.

There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges’ Workforce Model

Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving kidney replacement therapy. Methods: The KDIGO CKD Guideline Work Group defined the scope of the guideline and determined topics for systematic review. An independent Evidence Review Team systematically reviewed the evidence and graded the certainty of evidence for each of the review topics. Latest searches of the English-language literature were done in July 2023. Final modification of the guideline was informed by a public review process during summer of 2023 involving registered stakeholders. Recommendations: The full guideline included 28 recommendations and 141 practice points. This synopsis focuses on the recommendations that have the greatest evidence. Practice points reflect the expert opinion of the group where evidence is not that strong. Recommendations include greater emphasis on cystatin C for assessment of glomerular filtration rate, point-of-care testing in remote areas, a shift to an individualized risk-based approach to predict kidney failure, sodium–glucose cotransporter-2 inhibitors for some patients with CKD with and without diabetes, and statin use for adults older than 50 years and CKD. Together the recommendations and practice points provide guidance for how to evaluate and manage persons with CKD.

How Would You Manage This Patient With Obesity? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

In 2022, 1 in 8 people in the world were living with obesity, and lifestyle interventions that include diet, exercise, and behavioral modification have been the foundation for management of obesity. Recently, pharmacologic therapies have been developed for management of obesity, the newest of these being glucagon-like peptide 1 receptor agonists. With the development of new pharmacologic options, the American Gastroenterological Association developed a guideline in 2022 to provide evidence-based recommendations for the pharmacologic management of obesity in adults and recommended, for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions, adding pharmacologic agents to lifestyle interventions over continuing lifestyle interventions alone. In this article, 2 experts review the available evidence to answer the following questions: How effective are lifestyle interventions for the treatment of obesity? How effective are pharmacologic interventions for the treatment of obesity? Given these options, how do you engage in a shared decision-making discussion to develop a mutually agreed-on treatment plan?